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General NPI Number Information
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NPI Number | 1164591160
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Entity Type | Organization
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Legal Business Name | DR STEPHEN D FISHER DDS PC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 RIVERVIEW DRIVE
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City | POTSDAM
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State | NY
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Zip | 13676-2090
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Country | US
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Telephone | 315-265-2896
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Fax | 315-265-1035
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Provider Business Mailing Address
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Address Line | 1 RIVERVIEW DRIVE
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City | POTSDAM
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State | NY
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Zip | 13676-2090
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Country | US
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Telephone | 315-265-2896
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Fax | 315-265-1035
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN D FISHER
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Credential | DDS
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Telephone | 315-265-2896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 32526
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License Number State | NY
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